1/10. Massive hemoptysis caused by tracheal hemangioma treated with interventional radiology.Capillary hemangiomas of the tracheobronchial tree are extremely rare in adults, with hemoptysis being one of the most serious forms of presentation. An operation has been the treatment of choice, although it does involve high rates of morbidity and mortality, especially in emergency situations such as massive hemoptysis, which has led to the search for other therapeutic alternatives. There is no experience with embolization by interventional radiology when the hemoptysis is tracheal in origin, caused partly because the infrequency of this pathology; however, the foundations for it have been laid with the development of embolization for bronchopulmonary pathology. We report a case of a tracheal capillary hemangioma in a 66-year-old woman diagnosed with idiopathic thrombopenic purpura, which began as a massive hemoptysis and was treated successfully with embolization by interventional radiology. There has been no recurrence of the bleeding after 1 year's follow-up, and the patient's control fibrobronchoscopy is normal.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/10. Ingestion of tea tree oil (melaleuca oil) by a 4-year-old boy.A 4-year-old boy ingested a small quantity of tea tree oil. Within 30 minutes, he became ataxic and shortly thereafter progressed to unresponsiveness; he was endotracheally intubated by paramedics. His neurologic status improved gradually over 10 hours, and he remains well on follow-up. tea tree oil is an increasingly popular topical antiseptic that is available in a wide variety of products, often without warning labels. Healthcare providers should be aware of the common uses of tea tree oil, as well as its potential toxicity.- - - - - - - - - - ranking = 7keywords = tree (Clic here for more details about this article) |
3/10. Risks to infants on guam from bites of the brown tree snake (Boiga irregularis).The brown tree snake, Boiga irregularis, is abundant on guam and commonly invades human habitations. Data on emergency room visits on guam document a high frequency of snakebites on guam. Over 50% of the emergency room visits for snakebite involved children less than 4 years old. Records exist of 4 infants, 1, 2, 5, and 10 months old, who displayed significant symptoms after being bitten, while sleeping, by snakes. Two infants developed respiratory problems within a few hours and required medical treatment for asphyxiation. lethargy, diminished sensory perceptions, drooping eyelids, swelling, discoloration, and bleb formation were variable in occurrence in the patients.- - - - - - - - - - ranking = 5keywords = tree (Clic here for more details about this article) |
4/10. Acute dystonic reactions from "street Valium".Four patients presented to the emergency department with acute dystonic reactions 36 hours after the ingestion of "Valium tablets" they purchased on the street. Complete reversal of the symptomatology was achieved with the use of intramuscular diphenhydramine. The pathophysiology, epidemiology, and treatment principles for dystonic reactions are discussed.- - - - - - - - - - ranking = 5keywords = tree (Clic here for more details about this article) |
5/10. yohimbine: a new street drug.Following the ingestion of an alleged aphrodisiac known as "yo-yo," a 16-year-old girl experienced an acute dissociative reaction accompanied by weakness, paresthesias, and incoordination. Subsequent symptoms included anxiety, headache, nausea, palpitations, and chest pain. hypertension, tachycardia, tachypnea, diaphoresis, pallor, tremors, and an erythematous rash were noted on physical examination. serum epinephrine and norepinephrine levels were found to be elevated. Symptoms resolved spontaneously but lasted approximately 36 hours. The ingested substance was identified as yohimbine. The pharmacology of yohimbine and the treatment of yohimbine poisoning are discussed.- - - - - - - - - - ranking = 4keywords = tree (Clic here for more details about this article) |
6/10. Endoscopic retrograde cholangiography (ERC) in surgical emergencies.Twelve patients, presenting with an acute abdomen of suspected biliary tract origin, had endoscopic retrograde cholangiography performed. Eight patients had either traumatic, spontaneous, or postoperative biliary tract fistulas with five leading to the peritoneal cavity, one to the colon, one to the bronchial tree, and one to the liver parenchyma from a ruptured gall-bladder. Each was confirmed by endoscopic retrograde cholangiography. Four patients with jaundice, following traumatic rupture of the liver, had a pathological communication between the intrahepatic biliary tracts and the hepatic vascular system. It is concluded that ERC is a reliable method for obtaining precise localization of biliary tract problems in surgical emergencies both pre- and post-operatively.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/10. Emergency management of acute phencyclidine intoxication.phencyclidine (PCP) is a potent sympathomimetic and hallucinogenic dissociative anesthetic agent. As an abused street drug, it is most often smoked, thus allowing the user to titrate the dose. The clinical signs of PCP intoxication can be viewed in three dose-related stages, but waxing and waning of signs through the three stages is not uncommon. Treatment protocols for each stage address drug therapy and both clinical and psychological supportive measures.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/10. Upper gastrointestinal hemorrhage from a Mallory-Weiss tear associated with an occult Richter's hernia and small bowel obstruction: to see the forest as well as the trees in the emergency department.Mallory-Weiss tears are a common cause of upper gastrointestinal bleeding and are often associated with vomiting from heavy alcohol ingestion. Other causes of severe emesis can induce a Mallory-Weiss tear, and it may be important to diagnose these conditions so that appropriate therapy can be instituted. We report an unusual condition presenting with a Mallory-Weiss tear, a small bowel obstruction resulting from an occult Richter's hernia, which was not suspected or diagnosed at initial presentation.- - - - - - - - - - ranking = 4keywords = tree (Clic here for more details about this article) |
9/10. pancreatitis secondary to percutaneous liver biopsy-associated hemobilia.hemobilia refers to hemorrhage in the biliary tree and is most commonly associated with accidental and iatrogenic trauma. Rarely has pancreatitis been reported in association with hemobilia and never as a consequence of percutaneous liver biopsy-induced hemobilia. We report the case of a 64-yr-old man who presented with pancreatitis 6 days after a percutaneous liver biopsy. Within 24 h of admission, he developed hematochezia. Emergency endoscopy was performed, and with a side-viewing duodenoscope, blood and clot were clearly seen oozing from the papilla. The origin of bleeding was identified angiographically as a pseudoaneurysm of the right hepatic artery. Bleeding stopped and pancreatitis resolved after angiographic embolization of the hepatic artery pseudoaneurysm. A review of the English language literature reveals eight well-documented cases of pancreatitis associated with hemobilia, including the current report. Seven cases were associated with ruptured hepatic artery aneurysms and one case with hemorrhagic acalculous cholecystitis. Six of the patients received appropriate therapy to stop bleeding and recovered uneventfully. pancreatitis should be recognized as a potential important complication of hemobilia. In addition, hemobilia should be considered in the differential diagnosis for those patients with apparent biliary or idiopathic acute pancreatitis and no stones seen on ultrasonography. When bleeding is stopped via surgical or radiological methods, the clinical course of hemobilia-associated pancreatitis appears to be benign.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/10. The role of endoscopy in the treatment of acute traumatic anterior epidural hematoma of the cervical spine: case report.OBJECTIVE AND IMPORTANCE: Epidural hematoma (EDH) of the spine represents an uncommon neurosurgical disorder that sometimes requires emergent surgical decompressive therapy. Traumatic EDH of the cervical spine is exceedingly rare. The hematoma is usually located dorsally in the epidural space. We present one case of acute EDH located ventrally in the cervical spine. Special emphasis is placed on the role of spinal endoscopy in surgical treatment. CLINICAL PRESENTATION: After a fall from a tree, a 69-year-old man with rapidly increasing tetraparesis was referred to our institution. Plain films of the cervical spine revealed nothing abnormal. The results of computed tomography were highly suspicious for EDH. A myelogram and a post-myelographic computed tomographic scan demonstrated the lesion and its extent craniocaudally. INTERVENTION: Emergency decompressive surgery and removal of the hematoma were performed via an anterior approach. Control for total removal of the EDH was achieved using a flexible neuroendoscope providing visualization of the anterior epidural space from the foramen magnum to the T1 level. Surgery was accomplished by vertebral body replacement and anterior plating. CONCLUSION: Spinal endoscopy seems to be a useful tool in the surgical treatment of spinal EDH, providing control of the adjacent levels and allowing the limitation of the extent of bony resection.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
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